Inappropriately high left-ventricular mass was detected in 16.6% of patients with asymptomatic mild-moderate aortic stenosis and was associated with systolic dysfunction (88% vs 15%, P<0.01).
Cross-Sectional (n=1,614)
What is the prevalence and what are the covariates of inappropriately high left-ventricular mass in patients with asymptomatic mild-moderate aortic stenosis?
Inappropriately high left-ventricular mass is common (16.6%) in asymptomatic mild-moderate aortic stenosis and is associated with concentric geometry and reduced myocardial contractility, suggesting it is a marker of advanced myocardial disease.
Absolute Event Rate: 88% vs 15%
p-value: p=<0.01
OBJECTIVE: In some patients with aortic stenosis left-ventricular hypertrophy exceeds what is needed to sustain the hemodynamic load imposed by the aortic stenosis, a condition named inappropriately high left-ventricular mass (iLVM). Although iLVM is associated with increased mortality after aortic valve replacement, prevalence and covariates of iLVM in asymptomatic aortic stenosis are unknown. METHODS: We analyzed baseline data from 1614 patients (67 ± 10 years, 51% hypertensive) recruited in the Simvastatin Ezetimibe in Aortic Stenosis study evaluating placebo-controlled combined simvastatin and ezetimibe treatment in asymptomatic mild-moderate aortic stenosis. iLVM was diagnosed by Doppler echocardiography as LVM greater than 28% of the expected LVM predicted from height, sex and stroke work. RESULTS: iLVM was detected in 268 patients (16.6%), irrespective of concomitant hypertension. Patients with iLVM had higher body weight, LVM and relative wall thickness, higher prevalence of systolic dysfunction (88 vs. 15%) and lower left-ventricular afterload (all P < 0.01) than patients with appropriate LVM in spite of comparable aortic stenosis severity. In multivariate analysis, all these five variables were independently associated with iLVM. The simple coexistence of low stress-corrected midwall shortening and left-ventricular hypertrophy was the best clinical model describing iLVM phenotype (sensitivity 72%, specificity 96%, area under the receiver operating characteristic curve 0.954). CONCLUSION: iLVM is common in asymptomatic mild-moderate aortic stenosis and unrelated to severity of aortic stenosis or presence of hypertension. iLVM was associated with combined concentric geometry and reduced left-ventricular myocardial contractility, suggesting iLVM in asymptomatic aortic stenosis as a marker of more advanced myocardial disease.
Cioffi et al. (Fri,) conducted a cross-sectional in Asymptomatic mild-moderate aortic stenosis (n=1,614). Inappropriately high left-ventricular mass (iLVM) vs. Appropriate left-ventricular mass was evaluated on Systolic dysfunction (p=<0.01). Inappropriately high left-ventricular mass was detected in 16.6% of patients with asymptomatic mild-moderate aortic stenosis and was associated with systolic dysfunction (88% vs 15%, P<0.01).
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